Managing risks and harms associated with the use of anabolic steroids

Student thesis: Doctoral ThesisDoctor of Philosophy

Abstract

Background: People using AAS may adopt a range of strategies to prevent and treat adverse health conditions potentially associated with the use of these substances (AAS-HC). These strategies include seeking support from physicians, using the needle and syringe exchange programme (NSP) and seeking support from informal sources such as coaches and online forums. The process of identifying risks and harms, adopting and modifying health-related strategies is similar to the methods of risk-management employed in other fields of human activity. This approach recognises the importance of the informal body of knowledge produced by decades of AAS-related folk-pharmacology and seeks to understand harm-reduction from the users’ perspective.

Objectives: The primary objective of this thesis is to investigate the strategies adopted by people using AAS to prevent and treat AAS-HC. Secondary objectives include to explore the factors associated with the adoption of health strategies and the occurrence of AAS-HC, as well as the barriers and facilitators experienced by AAS users when accessing health services and other sources of support.

Methods: To achieve the objectives above, three work packages (WP) were produced as part of a mixed-methods research design. WP1 is a systematic review and meta-analysis of the prevalence of AAS users seeking support from physicians. WP2 is a cross-sectional online survey that identified AAS-HC, risk factors and health-related strategies adopted by AAS users in the UK. WP3 is a qualitative study based on in-depth interviews to discuss the experiences of AAS users and their risk-management strategies (RMS).

Results: The estimated overall prevalence of AAS users seeking support from physicians is 37.1%. Higher prevalence rates were observed in studies from Australia (67.3%) and amongst clients of the NSP (54.1%), whilst the lowest was observed among adolescents (17.3%). The health conditions most commonly reported by the 883 participants of the online survey were insomnia (33.3%) and anxiety (32.2%). Most participants adopted preventive strategies such as having blood tests in the last 12 months (86.2%) and seeking a GP to treat AAS-HC (55.0%). Those who sought a GP for AAS-related information were 76% less likely to report an AAS-HC in the last 12 months. The interviews described AAS users’ RMS as a continuous process of awareness and behavioural changes. Participants described an extensive use of private health services and other sources of support to bypass the barriers experienced by AAS users engaging with the public health system.

Conclusion: A large number of AAS users refrain from seeking support from physicians. Health professionals should be trained to recognise and manage the most common AAS-HC and help users improve their RMS. Further studies should investigate the efficacy of AAS-related RMS and the subpopulations of AAS users more likely to experience AAS-HC and less likely to engage with health services.
Date of Award1 Dec 2023
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorPaolo Deluca (Supervisor) & Andreas Kimergård (Supervisor)

Cite this

'